Glycaemic control and its determinants in diabetic patients in Ethiopia

A cross-sectional study was undertaken in which concentrations of glycated haemoglobins were measured in 102 diabetics seen at the outpatient clinic in Gondar, Ethiopia, between 26 January and 7 March, 1995. Mean HbA1, levels (standard deviations) were 5.35% (1.1) in non-diabetic controls, 12.0% (1.5) in 59 insulin-dependent diabetics, and 11.0% (2.0) in 43 non-insulin dependent outpatients. The majority of insulin-dependent mellitus (IDDM) (78%) and non-insulin-dependent mellitus (NIDDM) patients (77%) were poorly controlled (HbA1 > 10.8% in IDDM, and > 9.7% in NIDDM, respectively). Multiple linear regression analyses revealed that HbA1 levels were significantly positively associated with lower body mass index, duration of diabetes, a recent history of polydipsia, hypertension, and low income in NIDDM individuals. Whereas in IDDM patients lower age (or alternatively lower age at onset) was the only significant predictor. Whilst 49% of the model variance was explained by the predictors in NIDDM diabetics, only 9% were so in IDDM patients. Current fasting blood glucose level was marginally significant in NIDDM patients (r = 0.29; P = 0.058), but insignificant in IDDM individuals. This points towards the fluctuations in blood glucose levels experienced by IDDM patients in a setting where insulin supply is unreliable. It also confirms the doubts about the usefulness of fasting blood glucose values as a tool for assessing metabolic control.